By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach

Fears and anxieties around Covid19 have become very real in our current adaptation to a “new” way of working, living, learning and playing. Children may be picking up on our fears and we might be resonating theirs. Behaviors may escalate because of this and this might be good and bad. Not so good if we have more meltdowns and frustration to cope with, but perhaps good in the sense that we are more available to witness our children’s fears and anxieties.

Let us start at the beginning though. Fears and anxieties are actually very normal in early child development. As children approach the age of 4, having accomplished an important phase of separating from the parent to stand autonomous in their sense of self, they are also getting geared for “growing up” and becoming a “big boy or girl”. This creates a natural developmental stage wherein children may have more nightmares, bad dreams and monsters in their closets. As they learn to trust their new found autonomy, they fear less and these occurrences fade. If your children are still in their developing years, they may feel your concern about current events more strongly than if they were a year or two older. If your child is atypically developing though, then their sense of autonomy is likely not established at these early developmental stages and they may hang onto their fears and anxieties for a much longer time. Some hide it well and simply move through life, never really being fully “present”, always vigilant. Others disguise their fears and anxieties through defensive attitudes, seemingly wanting to control others through their behavior, yet feeling very insecure underneath.

Fear is exacerbated in a child with anxiety. If a child’s fear response is not curbed in a co-regulated, affective way, it could manifest itself into more extreme forms of mental health behaviors such as anxiety disorders later in their life.

The Amygdala & The Fight, Flight or Fright Response

Fear is an emotion linked to the amygdala, the small region in the temporal lobe of the brain’s limbic center named for its almond shape. Feelings of fear start with an environmental stimulus that provokes stress. The central part of the amygdala (CeA) reacts to this stimulus by regulating the release of cortisol through the paraventricular nucleus of the hypothalamus, which is responsible for what I like to call the “fight, flight and fright response.” The fear works subconsciously in the body; only after a child experiences the fear can their logic return so they can think of what to do next, rather than fight it, run from it or remain fearful.

The amygdala is directly associated with conditioned fear, defined as “the framework used to explain the behavior produced when an originally neutral stimulus is consistently paired with a stimulus that evokes fear.”

For example, if a child is having a difficult time dealing with their learning environment, their anxiety about that could give rise to a conditioned fear. The child will associate new learning experiences with the first anxiety provoking experiences and begin to form fear responses to other seemingly innocuous experiences, which will confound their teacher and parent alike. The child is responding to associated memories in similar circumstances and essentially generalizing their fears. 

Where Can A Child’s Anxiety Come From? 4 possibilities:

• Anxiety about family circumstances in the home
• Performance anxiety where a child is not able to keep up
• Social anxiety that makes a child feel like they cannot compare to their peers
• Traumatic experiences such as divorce or someone passing in the family

Having a fear response to a situation can cause a “normal” amount of anxiety with normal temporary fear responses. However, these feelings of intense anxiety or fear can become overwhelming for the child, and if this goes unrecognized and not addressed it can lead to the child exhibiting signs of an anxiety disorder.

Anxiety disorders are the most common mental health concern in the United States. More than seven percent of children ages three to 17 experience issues with anxiety each year. Over 40 million U.S. adults have an anxiety disorder and most people develop symptoms before age 21. The most common types of anxiety disorders include:

Generalized Anxiety Disorder (GAD) – a chronic, exaggerated worrying about everyday life.

Social Anxiety Disorder – an intense fear about social interaction

Panic Disorder – characterized by panic attacks or sudden feelings of terror that sometimes strike without warning and could cause chest pain, heart palpitations, dizziness, shortness of breath and stomach upset.

Phobias – an irrational fear of places, events or objects.

Other anxiety disorders are obsessive compulsive disorder (OCD), agoraphobia and separation anxiety disorder.

Normal Anxieties and Fears of Early Childhood

In his Touchpoints book series, renowned pediatrician T. Berry Brazelton, MD (They call him, “The Baby Whisperer”) introduces parents to the touchpoints theory, which follows a child’s pattern of  “growth-new challenge-regression-recharging-and renewed growth,” and applies it to the cognitive, behavioral and emotional developments that occur in children from ages three to six. He and co-author Joshua D. Sparrow also share guidance for parents facing the pressure of helping their children cope with the stresses of contemporary life, such as how to make a child feel safe without instilling fear, cope successfully with different family configurations, regulate through over-scheduling or competition and more.

Dr. Brazelton makes it clear that it’s very normal for children to experience moderate amounts of fear and anxiety in their early development – and one of the ways they work out fears and anxieties for themselves is through play. In fact, play is so important to healthy child development that it is recognized by the United Nations High Commission for Human Rights as the right of every child.

The Role of Play in Early Child Development

Why is play essential to healthy child development? The three core principles that guide child development are: 1) supporting responsive relationships; 2) strengthening core life skills; and 3) reducing sources of stress in order to help children and families thrive. Play is an effective way of supporting all three of these principles.

According to a publication in Pediatrics, the official journal of the American Academy of  Pediatrics:

• Play allows children to use their creativity while developing their imagination, dexterity, and physical, cognitive, and emotional strength.
• Play allows children to create and explore a world they can master, conquering their fears while practicing adult roles and problem-solving-decision-making skills.
• Play helps children develop new competencies that lead to enhanced confidence and the resiliency they will need to face future challenges.
• Play allows children to learn how to work in groups, to share, to negotiate, to resolve conflicts and to learn self-advocacy skills.

In addition to having an important role in healthy brain development, play allows children to develop a theory of mind and understand that another person’s thoughts may be different than their thoughts. Play also offers an ideal opportunity for parents to engage fully with their children.

How Does The Fear Response Relate to Flexibility?

When a child is responding to something with fear, their intent would be to find their comfort zone because they really don’t want to deal with a changing, unpredictable situation in the moment. Their parents may want to label the child’s behavior before it’s warranted (rigid, being inflexible, always wanting things their way, selfish), as their child’s response may seem extreme. Behavior usually is the outcome of what is going on underneath the surface. It may be that their child’s fear response is over exaggerated, which can be related to an anxiety trigger that can lead to inflexible behavior. It is a natural tendency in human behavior to want to control externally when we cannot feel in control inside. If the original anxiety is not addressed however, this may lead to forming habitual behavior patterns which may really be hard to break later.

When children are developmentally delayed emotionally, they weigh their fear against the reality of life versus their fantasy of life. For instance, if their parents get divorced before this milestone is cemented emotionally, they may feel their parents are getting divorced because of them. Maybe they remember their parents arguing about them before they learned of the divorce. Regardless of the reality of the situation between parents, the child will hold onto their fantasy about the argument and this becomes part of their subconscious system. Now, the child’s behavior is influenced by a fear that they have something to do with this big life event, increasing their experience of not feeling in control.

To return this type of rigidness to flexibility, parents can help their children return to a regulated state of acceptance and normal responses to fear.

Dr. Siegel’s Hand Model Of The Brain

If you put your thumb in the middle of your palm and then curl your fingers over the top, you’ll have a working model of the brain, he says. The forehead is at your knuckles and the back of your hand is the back of the head. Your thumb represents the amygdala tucked underneath your four fingers, and your wrist represents the brainstem from which the dorsolateral prefrontal cortex pathway (DLPFC) would commence. This pathway  is highly involved in the ability to understand the logic of a situation, the rationale behind things, the “why”.

If we encounter something we’re not expecting, we flip our lid (move four fingers straight up) exposing the amygdala (your thumb) making  our fight, flight and fright response available for these very primitive, impulsive response patterns. The pathway to our “thinking” brain’s logic has been severed and is not accessible for reasoning.

When a parent responds to their child’s fear, they usually want to appeal to their child’s logic. However, the child is in the fight, flight or fright response and the path to their thinking brain is not working. So first, the parent needs to close the prefrontal cortex and regulate their child down (close your fingers back into a fist to protect your thumb aka the amygdala), then access to your child’s logic may be restored. In essence, first normalize the emotion through your understanding and acceptance of that emotion with as little words as possible and wait for the “lid” to close the vulnerable Amygdala. 

Calming their fears and anxieties can be done through using any type of co-regulated activity. For instance, use your emotional tone of voice to calm your child, acknowledge how they’re feeling, bringing warmth and comfort into your response to normalize their behavior. Once the child has calmed down, you can say something like, “Wow, that was a scary (sad, mad) moment. I like the way you calmed down. This “praise” for calming down brings a sense of accomplishment that supports the child’s autonomy as this memory will now feed into the next occurrence. 

Nature Through Nurture – Be An “Amygdala Whisperer”

We must be very cognizant of the way we come across to our kids. Why? If the parents are high-strung and intense, you often see the same kind of behavior in their children or a behavioral response to the tension this creates. If the parents are more laid back and relaxed, their kids have more possibility to pick up on that and will tend to emulate it. No one likes feeling out of control and we should not assume that children get out of control because they “want to”. We want to feel this way, because their behavior makes us as parents feel out of control. How we feel in that moment, facing our child’s behavior has a direct correlation with what that child is feeling inside and no, the child does not have our ability to control it. Please do not feel guilty if you are not perfect. We all lose our cool from time and time and we learn from these experiences. What we are discussing here are patterns of behavior, established by too high frequencies of occurrence of perhaps misattunement between the needs of both parent and child. If you did lose your cool, simply go back to the child once your child has calmed down and give them a quick hug with these words: “Mommy/Daddy should not have lost my cool like that. I still do not like what you did, but know that Mommy/Daddy loves you.” This repair does more to fuel the child’s coping strategies as they build from your model. Of course, if this happens too frequently, the child may lose trust in your words over time.

Research shows that when children feel something, they feel it for at least a year before anyone ever knows they’re feeling it. They need time to work through what it is they’re really feeling.

As adults, we need to recognize that all children have anxieties and fears as they grow up, whether their early development is normal or they are developmentally delayed.

As they are building that foundation, it’s also our job to make sure they learn that normal anxiety could actually be helpful to them, during tough periods in their life, when they’re cramming for an exam and other experiences. If they start thinking that anxiety is their enemy, then life could become one constant timeline of rigid, inflexible behavior as self-protection.

What is it about “behavior” that makes me behave? How do I know what is expected of me socially? How do I keep friends and know to consider their wishes? Why do we see some kids struggle to make sense of it all and others take to these skills so readily? These are hard questions, though also quite simplistic.

 The word “behavior” has become a word connected to a child that is not doing what we expect them to do, acting in a socially immature way, creating difficulties in the home and at school and sometimes assumed to do these “behaviors” willfully. Most kids struggling with “behavior”, either have a haunted, sad look in their eyes or a daring attitude of defiance when we look their way. Others simply cringe at eye contact as if they could will themselves not to be seen. In the 1950’s Erik Erikson described the first year of life as the child’s foundation of trust vs. mistrust. Through the parent’s caregiving, and the child’s own temperament, they form the foundation of their relationships in life. Do they “trust” or “mistrust” that the important relationships in their lives will be there for them? Are they worthy of love? He identified this as the stage of hope. In the second to third year of life, this stage was identified as “willpower”. The conflicting issues at this stage was whether a child would have autonomy or shame. The will of the child could be formed in either direction. Would the child feel he is achieving or not?

 In much later research, this still holds true, though many more pieces have come to light. The Amygdala is a small center in the Limbic brain (emotional center), where the functions of fight, flight and freeze find their home. These functions are deeply seated in the subconscious brain. When something is in the subconscious brain, this means that when a child responds with fight and flight, it cannot possibly be because he or she wanted to. If it is triggered way “down under”, then the child is as much a victim of his or her own experience as the person on the receiving end would be. Think about when you are triggered on some of your hot spots as an adult. Do you not also wish you did not say something you did? And for the most part we call ourselves mature adults, which we are and I include myself in this experience, no judgment here.

 All of our experiences, from within our mother’s womb, until now is buried in the memory banks with our emotional connections to those experiences. If we truly ponder this, we realize what enormous influence our experiences have in our lives. If a child, for e.g. struggle with dysregulation and sensory processing of information and their experiences are fraught with mis-messages to their brain, their emotional experiences, however seemingly innocuous to us, are fraught with chaos, feeling anxious, uncomfortable and certainly not willing to do this again. They cannot trust new and novel experiences, which neurotypical children would thrive upon. And we scratch our heads. Every other child in the universe would enjoy spending the day on the beach with the family, but our child refuses to leave the car? It seems so incoherent to our typical nervous system that we turn to our frontal brain and logic tells us that the child is rude, obnoxious, selfish and out to make it difficult for all.

 You may ask why they could not simply override their need and come along just for the sake of their family? The answer again is both simple and complex. You are thinking with your pre-frontal cortex with good access to logic, while your child is responding to the limbic brain, reacting to the immediate need of fight and flight. While in that state, the child does not have access along the highway of logic in the brain, and is stuck in an instinctual response of self-protection. Self-protection you may ask? Yes, as the nervous system is not playing along as it should, giving us incorrect information about the moment, the child’s instinctual drive would be to go into self-protection whether it is fighting you or fleeing from you or even simply just freezing on the spot.

There is so much to say about this topic, especially how these reactions lead to rigid behavior, difficulty maturing socially emotionally and then there is a lot to say about what can be done about this. I will write more about it later. But if you do recognize this in your child, please do not allow anyone to put a behavior label on your child. Your child deserves more respect than a label could give. Seek services such as sensory integration therapy that absolutely can help this situation. Call us at 484 840 1529, no matter where you are or e-mail: maude@atotalapproach.com .

By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach

Oscar came into our lives over 11 years ago and wove his way into our hearts with his furry body, wagging tail and face that always laughed. He brought gaiety into our home and so much wonder. As I sit an ponder about missing him and his presence, I reminisce over some of the many lessons he taught us.

Oscar truly understood the art of being. For him it was only this moment, the only moment that could possibly count. Tomorrow was a concept only understood as a bedtime routine, and we will rise again tomorrow. He did not worry about if he was going to eat or going to get a new toy or if he was going to feel rejected, socially isolated, or achieve. He accepted what he got and tried to squeeze what he could from the moment he had. Children, especially at the younger ages, actually operate the same way. They are only concerned about today, not about tomorrow. While we worry about their future, their grades, having friends, they look to us with eyes that convey the silent message of “now”. What about today? How could we respond to them today? Does what we do today matter to what happens tomorrow? Yes, of course it does. Actually, worry does not do much more than increase thoughts around concerns, creating more anxiety instead of taking what today brings and fusing it into tomorrow. Of course, I am not saying we should not plan, more that every day consists of moments in time during which we could harvest every day problem solving opportunities that will support the many tomorrows to come.

Oscar had a certain vitality about life. He begged for life to be sniffed, explored, barked at and each of these he did with gusto and great fervor. When he saw a deer in our backyard woods, he would bark until we came to him and then he would shift his snout to show us: “Come and look”. Sometimes we could see the deer, other times, the possums and red foxes were only for his eyes. He would stand proudly erect, body stiff with excited tension and convey the message of his great find! We validated him and looked with him until he calmed down nicely and we could have our ears for ourselves again! Oh, what I would give to have one more of those moments! He begged us to recognize these daily events as part of our relationship, as the “food” that sheltered and built our companionship. What we miss is him, his relationship, his being, not what he achieved or not achieved. It is to hold him once more and shower him with the 100 kisses I gave him every day! His message to us is not to waste precious moments of growing up and living life. Capture the every day things that are happening and not only the wishes for tomorrow. What we have now is time and presence; tomorrow is the future, time is now.

Oscar trusted us to have his back. He knew he could rely on us no matter what. Children want the same from us as parents. More than knowing you will provide food on their table and clothes on their bodies, the need to know they are emotionally safe with you. That you are able to love them just the way they are and that you will help them gain the ground they need in order to thrive. For Oscar, only the relationship mattered. It did not matter if I picked his oldest, most tattered toy, as long as I flung it for him with my excitement about seizing this moment with him. It was bringing the stick back to us that mattered, not the actual stick. It was the “thing we did together” that counted.

Oscar was always on a leash when walking our neighborhood and even though we prefer the freedom of no leash, we realized very quickly that the leash was the boundary of safety we could provide for him. When he was unleashed he ran away in the woods a couple of times. On the other side of the woodsy area was a highway and not exactly what I would have had in mind for him. We needed to tighten the leash when he dawdled and sniffed too long, and we let go more when his pace was controlled and all was good. Kids need these boundaries too. They need to know when we tighten the leash it will ultimately be for the good of them and that we do know better, but within the parameters of the “leash”, we can give them room to freely explore what life has to offer. We were friends, but he knew who held the authority in our household. He may not always have understood why we tightened a leash or held him back when his exuberant greeting was too much for another dog, but he understood authority and accepted it.

Yes, I shed some tears again this morning, as the hole in my heart feels like a huge chasm that is going to be so difficult to bridge. He was our buddy, our companion, our constant laughter, our love. We have no regrets, he made sure every moment was seized. He fought valiantly and proudly against old age and all he really wanted was for us to be with him and love him. I realize he was a dog, but in so many ways much of it is the same with your kids. Deep down they want you and your time more than what you can or cannot provide. Even though you have to think for them from time to time, and yes, you do have to plan for the future, do not let the precious moments tick by of this day without seizing the shared joy that only relationship and companionship can bring. Oscar is so missed. We loved him so! Thank you to all our friends and families who have sent us well wishes upon his passing. He was well loved by many as he went to our therapy center every day with us. Thank you for enriching his life and therefor also ours!

Goodbye Oscar! You were a very special dog sent to us for a very special reason. Your gift was to allow us to see the richness of relationship, of “knowing” each other. Without words you communicated and you gave. Be safe, our friend, until we meet again!

By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach 

At A Total Approach, I support many children who are working through a sensory processing disorder (SPD) and learning to self-regulate their emotions. Many are picky eaters and may also demonstrate extreme sensory, emotional and behavioral responses to the taste, smell, sound and texture of foods when eating. 

Research shows that from birth to age eight, 20 percent of all children struggle with feeding challenges. As parents and as occupational therapists, we must be aware that eating a meal is a complex sensory experience. It involves the ambience of the dining room and the family dynamics during dinnertime such as conversation, cooking sounds and other distractions in addition to the qualities of different foods. Children also engage their motor planning skills when learning to sit at the table and to use forks, spoons and other utensils when eating.

Who Is The Picky Eater?

For a picky eater -and their parents- mealtimes can be stressful events. The picky eater can complain that foods taste or smell funny while the parents are constantly negotiating with them to eat what’s on the table. 

The picky eater may only eat certain foods like bread, pasta, crackers and white cheese -what’s known as a “white diet”. They may show signs of nutritional deficiencies due to these limited food choices as a result, such as being overly moody or sensitive, lacking vitality or looking unhealthy. 

Children with SPD may struggle to deal with all the sensory messages of mealtime. They may not want different foods to touch on their plates or to eat the same meal as the rest of the family. They may eat very few foods and avoid trying new foods. SPD can produce symptoms similar to eating disorders, which can lead to poor nutrition, significant weight loss or obesity.

Feeding as Nurture

For children and their parents, feeding is part of nurturing and nurturing is part of feeding. Many parents show love for their children through food. When feeding is not going well:

• Mealtime becomes a source of conflict
• The opportunity for bonding is lost
• Both parents and children put up barriers to attachment

The goal is to develop equilibrium and balance with feeding, which starts in infancy. Successful feeding depends on:

• Mother and child maintaining a calm, alert state during feeding.
• The coordination of sucking, swallowing and breathing during breast- and bottle-feeding.
• The orientation of the mother’s body and baby’s mouth towards the nipple.
• The ability of the child to signal hunger and satiation and the ability of the mother to read the cues and respond.
• Mother and child tolerating the body contact of feeding.

Source of Worry

Feeding is a huge source of worry for parents. Babies can pick up on a parent’s anxiety and may become resistant to feeding. If the child is experiencing modulation or regulation difficulties, they might not distinguish between feelings of hunger and satiation. The parents may resort to feeding the child to console them, which can start a cycle of needing to be fed when distressed. 

Biological factors can also come into play, such as malabsorption of food, tactile hypersensitivities and reflux, causing feeding to be a painful experience for the child. 

In our collective experience as occupational therapists, the following parental interventions can cause more harm than good:

• Forcing the child to eat food by placing it in their mouth.
• Putting food in front of the child’s mouth or on their lips until they eat it.
• Making the child take more bites after they have gagged on or vomited a food.
• Bribing the child to eat.
• Ignoring the emotional upset of the child when eating.
• Shaming or punishing the child for not eating.
• Staying away from the child until they eat.
• Making no eye contact or interacting with the child until they start eating.

Guiding Principles To Help Parents with Picky Eaters

Follow the child’s lead when it comes to them tolerating the food on the table. Expose them slowly to the smell, taste and touch of a food. If the child is pushing back or fighting about eating food, look for other options to get them to eat. It is also important to consider to first work on regulating the autonomic nervous system before the child will let go of the external need for control through picky eating due to not feeling in control on the inside. For this work you would need to work with your occupational therapist. 

You could try food chaining, which enables the child to try new foods that are similar to foods they currently enjoy and eat consistently. Use books about food during story time. Ask them why they like the foods they like and foods they don’t like. See if they can explain why they won’t eat a variety of foods. Help them by asking how the food tastes and feels in their mouth, what food flavors and textures do they prefer – salty, sweet, crunchy, creamy? Ask them if eating food makes their tummy hurt or makes them feel sick. 

Serve foods you want to eat as a family, establishing feeding rituals and predictable mealtime routines. Compare the child’s behavior only to themselves rather than to a sibling’s or even a parent’s behavior. 

Incorporate playful activities into eating like licking food, blowing bubbles in the food or spitting the food into a bowl or garbage can. Have them join in on meal prep in the kitchen, touching foods with their hands. Encourage the exploration of food and expect a mess. 

If the child may have a food allergy, medical condition or has difficulty chewing, seek the advice of a medical professional. Avoid any therapy occupational or otherwise that does not build relationships.

Sensory Integration Therapy from A Total Approach

Over the years of working in the field of developmental delay and sensory processing difficulties, we have witnessed many children struggle with picky eating and to make sense of their emotional responses.

Here are a few clinical interventions that could help: 

Tomatis Sound Training – This intervention is delivered through an electronic ear, a device that modifies music in a way that is stimulating to both sympathetic arousal and parasympathetic inhibition to impact the discrimination of different central nervous system pathways. 

DIR/Floortime Therapy – A comprehensive, developmentally-based model for assessment and intervention for children with special needs that empowers the parent to validate and support the child’s social, emotional and physical growth. 

Interactive Metronome Training – This is the only program that uses a patented auditory guidance system and a musical metronome plus interactive exercises to improve the foundational skills essential for learning and development by accurately measuring, assessing and improving rhythm and timing. 

Sandplay Therapy – Play is the language of children and the sand tray provides a safe medium for expression, free from judgment. When unable to effectively communicate needs, Sandplay therapy gives expression to non-verbalized emotional issues.

Learn More About How to Help A Picky Eater

If you’d like to learn more about how to help a picky eater, schedule a free phone consultation with one of our therapists who can give specific insight into our approach.

By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach

For most children, sensory modulation develops during the course of ordinary childhood activities. If this process is somehow disrupted, a child may develop sensory modulation disorders (SMD) that interfere with their behavior, learning ability, social skills and self-esteem. They will also have trouble with emotional regulation.

The inconsistent responses of a child with SMD to sensory stimuli are less about willful behavior and more about how their system adapts and the coping strategies available to them at any given moment.

An important influence for a SMD child’s inconsistent performance is how they are sleeping. 

Adequate amounts of restful sleep give us the foundation for our best participation and engagement in daily life. When we work with children who exhibit developmental delays, first we explore the impact of sleep habits on the child and the family to determine their ability to function effectively during the day. 

Definition of Sleep

Physician Robert MacNish, who wrote The Philosophy of Sleep in 1830, describes sleep as a “suspension of sensorial power”, an altered state with a natural lessening of conscious awareness of the external world. The sleep state is transient, periodic and physiological, characterized by reduced responsiveness to environmental stimuli. It is also reversible, meaning people awake from sleep, which differentiates it from death or coma. 

Sleep is regulated by a homeostatic process and a circadian process that interact to determine sleepiness and alertness. These two processes are described scientifically as follows: 

A homeostatic sleep debt process refers to the drive for sleep that increases as a saturating exponential when we stay awake and decreases exponentially when we sleep, and a circadian process refers to the internal oscillatory rhythm that runs about 24 hours and can be reset by the environmental light.

Theories On Why We Need Sleep

Philosophers and scientists have been studying why people sleep since the dawn of medicine. Adaptive and instinctive, sleep:

• restores and repairs our bodies, creating metabolic homeostasis
• conserves our energy
• strengthens the integrity of our synaptic and neuronal network
• clears our minds of extraneous thoughts and consolidates our memories
• regulates our body temperature
• improves endocrine regulation of our immune systems

The Impact of Sleep Deprivation

Sleep also affects our emotions. Research shows people who sleep poorly or aren’t sleeping enough find it more difficult to recognize expressions of emotion like anger or happiness. Lack of sleep can also limit their social skills. 

Sleep deprivation is so prevalent in our society, it’s become an unmet public health problem. According to a report funded by the National Institutes of Health, an estimated 70 million Americans chronically suffer from a sleep disorder that hinders daily function and adversely affects health and longevity. 

When children are sleep deprived, it manifests through emotional and behavioral symptoms that include aggressive or delinquent behavior, reduced attention spans and a variety of social difficulties. Children can also experience sleep disorders associated more with adults such as insomnia, narcolepsy, sleep apnea and others. 

When a child comes to us with a sensory modulation difficulty, our first course of action that initiates any intervention program is to explore their sleep habits. Using sleep questionnaires, we help families make systematic changes in bedtime routines and suggest calming activities and other routines to facilitate sleep that do not burden the family and can be carried out consistently.

Tips To Create a Bedtime Routine That Promotes Healthy Sleep

• Select a specific bedtime for each child based on their age and schedule.
• Get your child relaxed and ready for bed with a predictable, regular sequence of events.
• Reinforce the bedtime routine with your child by explaining the routine step-by-step, then remind them of what’s coming, like, “First we eat dinner, then we play, then we’ll take a bath and put on our pajamas. Then we read a story and then get into bed to go to sleep.”
• Begin the relax-and-ready routine about a half hour before bedtime.
• If your child wants a drink, try a glass of warm milk, which is scientifically linked to improved sleep.
• Avoid having your child drink too much liquid before bedtime, however.
• Offer your child a light snack of foods high in tryptophan, such as bananas and cheese, to help them feel drowsy.
• Encourage your child to be part of the process. Ask them what step of the routine comes next, for example.
• Have your child pick up and put away toys.
• Turn off the TV and play soothing music during the bedtime routine.
• Prepare your child’s bedroom for healthy sleep. Keep the lights low and the temperature cool.
• Have your child take a warm bath, adding lavender or Epsom Salts to the bathwater.
• Offer your child choices of books to read and music to listen to or songs to sing.
• Suggest that your child take a favorite doll or stuffed animal or a favorite blanket to bed with them.
• Be consistent with bedtimes during the week, on weekends and even during vacations.

Tips for Increasing Your Child’s Comfort at Bedtime

• Check your child’s sensory experiences at bedtime. Are their pajamas or bed blankets itchy? Do the fabrics breathe? Is the room too warm? Too cool? Do the window coverings let in too much light?
• If your child expresses a fear of the dark, help them overcome the fear in a safe, supported environment. Make statements such as: “I believe in you,” or “I know you can do it”.
• Incorporate supportive actions into the bedroom routine, like checking the closet or under the bed for danger.
• Switching on a nightlight in your child’s room can help reduce their fear of the dark. Avoid lights with a blue or green cast as they inhibit the production of melatonin in the brain and can prevent your child from feeling drowsy at bedtime.

Learn More About Sensory Integration Therapy

If you’d like to learn more about the different methods we use for sensory modulation and emotional regulation, such as Tomatis sound therapy, Interactive Metronome therapy and others, I recommend scheduling a free phone consultation with one of our therapists who can give specific insight about you and your child’s situation.

By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach

When we study a child’s development, we look at it through a sensory lens and an emotional lens. That’s because sensory modulation and emotional regulation work together to form a whole picture of the child’s behavior. Without one or the other, any therapeutic intervention may not give the results we’re looking for.

No discussion on the emotional triggers of regulation is complete without first talking about the sense of self that develops at an early age and the difference between temperament and personality.

Some call temperament the “why” behind personality and it is, in many ways. While personality arises within an individual and is made up of certain characteristics, temperament is the inherited style of an individual, often referred to as their natural instinct or emotional constitution.

Parents can nurture a child’s temperament, which gives clues about their strengths and weaknesses. Personality develops over the years and can be influenced by education, social status and the stress of life events. The characteristics of personality are consistent but can be expressed in a multitude of ways.

What is Emotional Self-Regulation?

During his lifelong study of emotion regulation, Dr. Stuart Shanker has observed that every time children are confronted with stress, their brains respond with processes that consume energy, followed by restorative processes to recover from the energy expenditure. Therefore, he defines emotional self-regulation as how effectively a child responds to environmental stressors in the moment and how efficiently they recover from the effort.

A child who merely misbehaves in any given situation will realize they could have acted differently, that they are perfectly capable of acting differently. Whereas a child who demonstrates stress behavior is not fully aware of their actions or the reason for their actions. They have limited capacity to act differently in a stressful situation.

The challenge for parents and occupational therapists in helping the child learn how to regulate their emotions is understanding why certain levels of stress stop the child from an effective, efficient response.

Dr. Shanker’s Five Domains of Stress

To help reduce a child’s stress level that is affecting their behavior, first recognize and identify the stressors across five domains:

1) Biological Stressors – Noises, crowds, too much visual stimulation, not enough exercise, lack of sleep, eating junk food

This domain refers to the physiological process of burning energy and restoring it. It involves sensorimotor challenges and sensory adaptive responses influenced by nutrition, sleep and exercise.

2) Emotional Stressors – Strong emotions, both positive and negative

This domain taps into the child’s understanding and management of their emotions and what to do when they are overwhelmed. Have they developed language to express their feelings in the moment? Temperament plays a role here. The emotional domain can also impact the biological domain.

3) Cognitive Stressors – Difficulty processing certain kinds of information

This domain engages the memory, information processing, reasoning, problem-solving, shifting and sustaining attention, self-awareness and thought sequencing- how to plan and carry out steps to achieve a goal.

4) Social Stressors – Difficulty picking up on social cues or understanding the effect behavior has on others

This domain accesses relationship skills and the ability to adapt behavior in social situations like making friendships that last, taking turns in conversation, picking up on social and non-verbal cues and understanding how emotions affect other people’s behavior.

5) Prosocial Stressors – Difficulty coping with other people’s stress

This domain relates to spiritual, aesthetic, humanitarian and intellectual development and internal standards and values. It brings into play empathy, selflessness, social responsibility, connecting with others within group dynamics and the smooth shift from me-centered to we-centered thinking.

All of these stressors influence a child’s ability to regulate their emotions. If they can’t make sense of an emotion that they’re experiencing in a physiological way with the right adaptive response, how can they self-regulate?

Hierarchy – Levels of Regulation

I use these levels of intervention when treating children with developmental delays as related to sensory processing and self-regulation:

Level 1: Sensory Modulation coupled with Emotional Regulation

• Depends on the emotional co-regulation of the parent-child bonding process

Level 2: Sensory Discrimination

• Registering and processing information in an adequate speed and pace
• Accurately grade sensory information to match the intended intensity from auditory, visual, touch, movement, deep pressure, smell and taste stimuli

Level 3: Praxis

• Series of exams to measure anxiety-related to performance demands
• Performance anxiety due to not performing exactly as my brain wants to cognitively dictate

Level 4: Timing

• Sequencing and bilateral integration includes the ability to regulate time, handling the passage of time, pacing self through activity

 Level 5: Executive Skills

• Cognitive skills used to plan, organize and execute a task, make decisions, shift between situations or thoughts, control emotions and impulsivity, be an active problem-solver and learn from past mistakes
• Requires the regulation of timing between all systems to impact interhemispheric function and attention regulation

To bring about emotional self-control requires secondary structures early in life. Detecting, monitoring and evaluating dynamic affective-state changes is impacted by registration and discrimination challenges. Inhibiting or modifying emotional reactions is impacted by the ability to inhibit over-arousal as well as excite under-arousal. Assuring automatic self-control over time is impacted by praxis, sequencing and timing.

Our occupational therapists can help your child’s emotional regulation skills by working on focusing attention, filtering distractions, controlling impulses and coping and calming behaviors to improve self-regulation. 

Learn More About Emotional Regulation

If you’d like to learn more sensory modulation and self-regulating emotions, schedule a free phone consultation with one of our therapists who can give specific insight into our approach.